Addressing The Biomechanics Of Stage II Adult-Acquired Flatfoot

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Understanding The Progression Of The Adult-Acquired Flatfoot Deformity

1. Preexisting flatfoot deformity
2. Pronated position of the subtalar joint creates increased friction and gliding resistance of the posterior tibial tendon
3. Posterior tibial tendon gradually attenuates and ruptures
4. Pronated subtalar joint creates increased mobility of the forefoot on the rearfoot, increasing strain on the supportive ligaments
5. Sequential ligament rupture occurs beginning with the spring ligament and followed by the long and short plantar ligaments as well as the superficial and deep deltoid ligaments
6. Progressive flatfoot deformity occurs and is characterized by hindfoot valgus, lowering of the medial longitudinal arch and forefoot abduction

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Author(s): 
Douglas Richie, Jr., DPM, FACFAS, FAAPSM

25. Williams G, Widnall J, Evans P, Platt S. Could failure of the spring ligament complex be the driving force behind the development of the adult flatfoot deformity? J Foot Ankle Surg. 2014;53(2):152-5.
26. Haddad SL, Myerson MS, Younger A, Anderson RB, Davis WH, Manoli II A. Adult acquired flatfoot deformity. Foot Ankle Int. 2011;32(1):95-111.
27. Ness ME, Long J, Marks R, Harris GF. Foot and ankle kinematics in subjects with posterior tibial tendon dysfunction. Gait & Posture. 2008;27(2):331–339.
28. Rattanaprasert U, Smith R, Sullivan M, Gilleard W. Three-dimensional kinematics of the forefoot, rearfoot, and leg without the function of tibialis posterior in comparison with normal during stance phase of walking. Clin Biomech (Bristol, Avon). 1999;14(1):14-23.
29. Ringleb SI, Kavros SJ, Kotajarvi BR, Hansen DK, Kitaoka HB, Kaufman KR. Changes in gait associated with acute stage II posterior tibial tendon dysfunction. Gait Posture. 2007;25(4):555–64.
30. Houck JR, Neville CG, Tome J, Flemister AS. Ankle and foot kinematics associated with stage II PTTD during stance. Foot Ankle Int. 2009;30(6):530-9.
31. Myerson MS, Badekas A, Schon LC. Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int. 2004;25(7):445–450.
32. Otis JC, Gage T. Function of the posterior tibial tendon muscle. Foot Ankle Clin. 2001;6(1):1–14.
33. Wacker J, Calder JD, Engstrom CM, Saxby TS. MR morphometry of posterior tibialis muscle in adult acquired flat foot. Foot Ankle Int. 2003;24(4):354–357.
34. Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ. 2004;329(7478):1328–1333.
35. Hansen ML, Otis JC, Kenneally SM, Deland JT. A closed-loop cadaveric foot and ankle loading model. J Biomech. 2001;34(4):551–555.
36. Kulig K, Burnfield JM, Requejo SM, Sperry M, Terk M. Selective activation of tibialis posterior: evaluation by magnetic resonance imaging. Med Sci Sports Exerc. 2004;36(5):862–867.
37. Flemister AS, Neville CG, Houck J. The relationship between ankle, hindfoot, and forefoot position and posterior tibial muscle excursion. Foot Ankle Int. 2007;28(4):448–55.
38. Neville C, Flemister A, Tome J, Houck J. Comparison of changes in posterior tibialis muscle length between subjects with posterior tibial tendon dysfunction and healthy controls during walking. J Orthop Sports Phys Ther. 2007;37(11):661-9.
39. Neville C, Houck J. Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction. J Orthop Sports Phys Ther. 2009;39(11):816–824.
40. Chao W, Wapner KL, Lee TH, Adams J, Hecht PJ. Non-operative management of posterior tibial tendon dysfunction. Foot Ankle Int. 1996;17(12):736–41.
41. Augustin JF, Lin SS, Berberian WS, Johnson JE. Non-operative treatment of adult acquired flat foot with the Arizona brace. Foot Ankle Clin. 2003;8(3):491 –502.
42. Alvarez RG, Marini A, Schmitt C, Saltzman CL. Stage I and II posterior tibial tendon dysfunction treated by a structured non-operative management protocol: an orthosis and exercise program. Foot Ankle Int. 2006;27(1):2–8.
43. Lin JL, Balbas J, Richardson G. Results of non-surgical treatment of stage II posterior tibial tendon dysfunction: a 7- to 10-year followup. Foot Ankle Int. 2008;29(8):781-6.
44. Krause F, Bosshard A, Lehmann O, Weber M. Shell brace for stage II posterior tibial tendon insufficiency. Foot Ankle Int. 2008;29(11):1095-1100.
45. Nielsen MD, Dodson EE, Shadrick DL, Catanzariti AR, Mendicino RW, Malay DS. Non-operative care for the treatment of adult-acquired flatfoot deformity. J Foot Ankle Surg. 2011;50(3):311-314.
46. Valderrabano V, Hintermann B, Wischer T, et al. Recovery of the posterior tibial muscle after late reconstruction following tendon rupture. Foot Ankle Int. 2004;25(2):85–95.

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